Celle finally had a breakthrough

[Melissa and Celle]

She's on Lantus now, but since I got so much help here trying to get Levemir to work, I thought I'd share the good news.

The first four doses at 3.75 units looked like I expected, then I had a fur shot, which seemed to throw things totally off, and then suddenly for four days straight we get nothing higher than a 313?? As far as I'm concerned this is the dose we want. Chasing perfection led to months of really, really bad numbers on Levemir and a very slow climb back to where we are on Lantus.

I also thought it's worth sharing my experience here for those that come after me. Basically I'm convinced that what I was doing with Levemir was NOT the right thing to do. Pre-shots kept climbing as the dose went up. With Lantus, I didn't see that. Pre-shots didn't fall for a long time and seemed to increase in variability, but at least the average value held steady while the middle of the curve fell.

Of course, I don't really know what exactly I was doing wrong because two things changed. For one, the insulin changed -- maybe Levemir just doesn't work for everyone. Second, I held doses for a long time (at least a week, and longer when I thought she might be bouncing and needed more time to get used to the reduced values). I was raising the Levemir dose every 3 days. Perhaps I was too conservative with Lantus and kept her high for longer than she needed, but it's hard to recover if you go too fast.

I just hope things hold for a while and I'm not declaring victory too soon. I do have a couple of questions now that we're in new territory of low numbers:

• (1) Given her data, what pre-shot values would make you nervous? She's so variable, that I expect to eventually get something significantly lower than I've seen so far.
  (2) I'll have some time off over the holidays. What data is most important to get? I don't want to torture her with a curve every day just because I'm home.
  (3) Does this dose so far seem safe enough for my sitter to use while we're gone (for four shots) over Christmas, given that the sitter doesn't check BG?

 

[Sheila & Beau GA & Jeddie GA]

I just hope things hold for a while and I'm not declaring victory too soon. I do have a couple of questions now that we're in new territory of low numbers:

• (1) Given her data, what pre-shot values would make you nervous? She's so variable, that I expect to eventually get something significantly lower than I've seen so far.
  (2) I'll have some time off over the holidays. What data is most important to get? I don't want to torture her with a curve every day just because I'm home.
  (3) Does this dose so far seem safe enough for my sitter to use while we're gone (for four shots) over Christmas, given that the sitter doesn't check BG?

Melissa, I wouldn't worry about holding the dose longer - some kitties need a long time to settle on a dose. Her numbers look good in the past few days, but she could still settle a bit more. Maybe the PSs will come down instead of the middle numbers (I mean the nadir will hold where it has been which looks good).

Answers:
#1 - nervous in what way? Too low? Too high? I would not raise her dose on one or two higher numbers. As for lower numbers, you don't have a lot of data to show how she will react on them with a full dose. You are supposed to be able to shoot full doses on even low PS's, but I would only do that if you are going to be around to get spot checks the first few times. Otherwise, reduce a bit, or wait, don't feed, and retest to see if she is rising.

#2 - get some spot check at random times, or test one day at +2, +6, +10 and the other day at +4, +8. Or test every 3 hours (+3, 6,9).

#3 - This is a tough one as I think she is still settling on this dose. Will she be able to free feed? Is the sitter only going to be there at feeding/shot times? It might be safer to have the dose reduced just a tad to 3.5u. She seemed perfectly safe on that dose. You will loose some momentum, but should get it back in anther few days.

 

[Melissa and Celle]

#1 - nervous in what way? Too low? Too high? I would not raise her dose on one or two higher numbers. As for lower numbers, you don't have a lot of data to show how she will react on them with a full dose. You are supposed to be able to shoot full doses on even low PS's, but I would only do that if you are going to be around to get spot checks the first few times. Otherwise, reduce a bit, or wait, don't feed, and retest to see if she is rising.

I meant nervous that she's too low to shoot. How long does it take for the effect of food to kick in, and how long does it last? I won't know if she's eaten shortly before the first test because she free feeds.

#3 - This is a tough one as I think she is still settling on this dose. Will she be able to free feed? Is the sitter only going to be there at feeding/shot times? It might be safer to have the dose reduced just a tad to 3.5u. She seemed perfectly safe on that dose. You will loose some momentum, but should get it back in anther few days.

She'll be free feeding. The sitter will only be there for shot times.

Thanks for the help Sheila!

 

[Sheila & Beau GA & Jeddie GA]

If she free feeds, it is not like putting a dish down twice a day where they scarf it all down in one sitting. Free-feeders should have a more even keel of BGs because they take a few bites every few hours.

As to how fast and how much food effects BGS it depends on so many factors - one of those ECID situations for sure. You can only know if you have data showing you how she reacts to a meal BG-wise. Sorry - I know that isn't too helpful. :roll: